Customer IP
Date
Account Number*

Account Number will be referenced on your billing statement.

Confirm Account Number*

Incorrect or partial account number may cause delay or denial of payment.

Payment Amount*
Total Payment
Name as on Card*
Card Billing Address*
Card Billing Zip*
Card Number*
Card Expiration Date*
CVV2/CID*
Phone Number*
First Name*
Last Name*
Address*
Address 2
City*
State*
Zip*
Receive a Confirmation (yes/no)*

   If you select 'Yes' be sure to enter a valid email address below in order to receive a confirmation.

Enter Confermation Email Address

   If you do not receive a confirmation, contact the billing department before making another payment.

Payment Authorization*


Payment Authorization: You must be authorized to use the payment card. By selecting 'I Agree' and submitting payment information through this Service You agree to the terms and conditions of this Agreement and any documents incorporated by reference. You further agree that this User Agreement forms a legally binding contract between me and AR Billing Services and that this Agreement constitutes "a writing signed by you" under any applicable law or regulation. Any rights not expressly granted herein are reserved by AR Billing Services. Please save or print this authorization for your records.

Please verify your account and payment information before submitting a guest payment. Incorrect information can cause denial or delay of payment. Refunds will be submitted on over-payments by mailing a paper check and once those funds have been received. Electronic Banking can take up to, but not limited to, 7 business days to fully process (funds are received by our bank). If you are not sure the guest payment completed, please contact the billing department before submitting another payment. If you make a double payment, each payment will be applied to your account/balance due.